Reducing Major Depressive Episodes With Online Mental Health Treatment
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Depression: Global prevalence, symptoms, mood, and treatment
The World Health Organization estimates that 5% of adults experience depression worldwide. Depression is different from feelings of sadness for several reasons. While sadness tends to be short-lived, depression lasts for two weeks or more and can have serious symptoms that affect a person in numerous ways. In addition, depression can significantly impair a person’s day-to-day functioning. However, there are effective treatments available, including therapy and medication.
Reducing depression and managing the risk of side effects
Below, we’ll discuss major depressive episodes, online interventions to reduce depression symptoms, and ways to manage potential side effects, all aimed at improving overall well-being.
Major depressive episodes: A type of depression
While all major depressive episodes are a type of depression, not all depression symptoms lead to a diagnosis of a major depressive episode. Harvard Health Publishing identifies six different types of depression, including major depression. This is the most commonly recognized type of depression and is often characterized by a constant dark mood and loss of interest in activities. Other depression symptoms may include changes in sleep patterns (sleeping too much or too little), weight loss or gain, and suicidal thoughts.*
Statistics from the National Institute on Mental Health
According to recent statistics from the National Institute of Mental Health, approximately 21 million adults in the U.S. experienced a major depressive episode in the past year (according to a survey in 2020). While this constitutes 8.4% of all U.S. adults, these episodes are most prevalent in those between 18 and 25; 17% of adults in this age group experienced an episode in the past year.
Despite these high numbers, one in three adults experiencing a major depressive episode did not seek treatment in the past year, yet effective treatments are available. Care can often include one or more treatments, including antidepressants, cognitive behavioral therapy (CBT), interpersonal therapy, psychodynamic counseling, or a combination.
Major depressive disorder vs. bipolar disorder
Bipolar disorder and major depressive disorder (MDD) are both identified as types of mood disorder. Patients with MDD show depressive episodes only. Bipolar disorder (BD) patients not only show depressive episodes but also manifest manic/hypomanic episodes.
Both MDD and bipolar disorder have depressive episodes
The depressive episodes are the overlapping symptoms of MDD and bipolar disorder. A study cites that most of the patients with bipolar disorder first show depressive episodes rather than mania or heightened moods. The most common misdiagnosis of BD is unipolar depression. Careful screening of the symptoms is crucial for proper diagnosis and treatment.
Online CBT and incidence of major depressive episodes
Although CBT has been proven to be effective for major depressive episodes, several barriers often limit individuals from seeking this therapy. Providing CBT requires having trained professionals available to serve a community, which is not always the case, especially in smaller or more rural areas. Also, sometimes stigmas associated with mental health challenges can prevent treatment. In addition, limited time, money, and transportation can be barriers to CBT.
iCBT: Flexible treatment for reducing major depressive episodes and symptoms of depression
Internet-based cognitive-behavioral therapy (iCBT) is an increasingly popular treatment that bypasses many barriers. The virtual nature of iCBT often allows for greater flexibility, and several studies have examined its effectiveness in reducing depression symptoms in various populations or preventing its incidence altogether.
Research on mental health conditions and online interventions in reducing symptoms of depression
One study on depression in workers in Japan examined whether a specific iCBT program decreased symptoms of subthreshold depression.
Participants
Approximately 1,790 individuals were recruited from two information technology companies in Japan during 2011. Recruitment occurred through invitation emails sent by company management. Exclusion criteria included:
- Diagnosis of a major depressive episode within the past month (which was determined by using an online, self-administered version of the WHO Composite International Diagnostic Interview 3.0)
- Diagnosis of lifetime bipolar disorder
- Sick leave of 15 or more days due to personal health issues in the past three months
- Medical treatments for mental health problems within the past month
Out of the 850 individuals who opted to complete a baseline survey, 762 participants fulfilled the inclusion criteria. They were randomly placed within the intervention and control groups, with 381 in each.
The intervention
Those in the intervention group were provided a six-week, six-lesson virtual CBT program covering self-monitoring, cognitive restructuring, assertiveness, problem-solving, and relaxation. Homework was submitted voluntarily, and those who did complete the homework received feedback from trained psychologists. Five clinical psychologists provided feedback on a first-come, first-served basis as homework was submitted.
Participants in the intervention group were asked to finish the program within 10 weeks of the baseline survey. Email reminders prompted them to complete lessons and homework, but no incentives were provided. Also, company management was not informed of who completed their lessons and who didn’t.
Stress management in the control group and iCBT
Those in the control group received monthly emails about non-CBT stress management tips for the six months following the baseline survey. These emails covered topics such as forming healthy sleep habits and limiting alcohol intake. In addition, all employees from one of the two IT companies were provided a virtual session on stress management. After the six-month follow-up, people in the control group were given entry to the iCBT program.
Results
Among those who responded at follow-up, participants in the intervention group experienced more significant improvement in depression symptoms at three-month follow-up than participants in the control group. This study suggests that online interventions can be effective for non-clinical populations experiencing subthreshold depression symptoms.
Improving mental health conditions & reducing the incidence of major depressive episodes
Reducing the incidence of major depressive episodes often involves both prevention and treatment. Ideally, the goal is to prevent many people from ever experiencing depression by offering preventive care and education. However, for those who have already experienced or currently have major depression, treatment can be used to reduce symptoms and the duration of major episodes.
Preventative measures and treatment for major depressive episodes
Speaking to a licensed therapist can be an important part of treating or preventing major depressive episodes. For those whose depression symptoms make it challenging to leave home, online interventions can be effective in reducing their symptoms. The methods below include both preventive measures and treatment options for major depression.
Resilience development and mental health conditions
One factor that may help prevent major depressive episodes is the development of resiliency. Resilience prepares individuals to overcome hardships in life, and those with low levels of resilience may be more prone to mental health challenges. The Center on the Developing Child at Harvard asserts that the most important factor in developing resilience is at least one stable relationship with a caring adult, such as a parent, family member, or teacher.
Cognitive behavioral therapy for major depressive disorder to minimize side effects
Cognitive behavioral therapy (CBT) can serve as an effective treatment for depressive episodes, and it can be delivered online. Many studies have examined the efficacy of internet-delivered CBT (ICBT) and found it to be effective for depression and other mental health conditions, including generalized anxiety disorder.
Family intervention for mood, mental health, and risk reduction
Family cognitive behavioral interventions, which focus on modifying negative thought patterns and behaviors within the family unit, have proven effective in addressing various mental health issues. One of the risk factors for depression is parental depression. A method that addresses depression in caregivers acts as both prevention for possible future episodes and treatment for current episodes of depression. One study found that using a family-focused method to work with children and their parents who had a history of depression reduced symptoms significantly. Per the study, “Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures.”
Takeaway
What is required to diagnose a major depressive episode?
To diagnose depression, a mental health care professional must evaluate a patient using the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The criteria for major depression (major depressive disorder) include having a low mood and/or anhedonia (inability to enjoy activities) in conjunction with other symptoms, such as psychomotor agitation (restlessness), sleep disturbances, unexplained physical aches, weight gain or loss, difficulty concentrating, and excessive guilt. Depressed mood and related symptoms generally must last for at least two weeks and cause clinically significant distress. Depression can occur at any age, but it is most commonly seen in young adults.
For an accurate diagnosis, healthcare providers rule out other mental and physical health conditions that can cause similar symptoms. For example, depressive symptoms may be a sign of a medical condition, such as hyperthyroidism and other thyroid disorders. However, it is possible to have both depression and a medical condition at the same time.
What can trigger a depressive episode?
Several factors can contribute to an increased risk of a depressive episode. The most predominant risk factor seems to be medical history: having a previous depressive episode increases the risk of having another, and the risk compounds with each episode. Other factors include a family history of depression, pre-existing medical conditions like heart disease or chronic pain, substance use, isolation, brain chemistry, and the presence of other mood disorders.
Psychosocial stressors like stressful events, financial instability, and interpersonal problems may also increase the likelihood of developing depression. Depression may also be related to certain personality traits, such as low self-esteem and negative thinking. However, these personality traits are not exclusive to individuals with depression.
How long does a depressive episode last?
Depressive episodes can last anywhere from a couple of weeks to several months or years. The average duration is between six months and one year. In one study, around one in 10 participants hadn’t recovered after three years. Choosing to seek treatment from a mental health professional can reduce the length of an episode and lower the risk of developing chronic major depression. A healthcare provider can also help individuals with depression develop coping skills to manage their symptoms and navigate everyday life stressors.
Is MDD the worst type of clinical depression?
Everyone’s experience of depression is different, even among people with the same disorder. Severe forms of major depression, seasonal affective disorder, perinatal depression or postpartum depression, and other depressive disorders can contribute to poor outcomes, including lost productivity, relationship strain, self-destructive behaviors, and suicide attempts. Major depressive disorder can also co-occur with other mental disorders, such as panic disorder and other anxiety disorders, eating disorders, psychotic disorders, and substance use disorder.
How do you stop a depressive episode?
Several medical and individual interventions can alleviate depression symptoms:
Talk therapy: Cognitive-behavioral therapy, dialectical behavior therapy, and acceptance and commitment therapy are a few effective treatment options for depression.
Antidepressant medications: There are several classes of antidepressant medications, such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclics, and monoamine oxidase inhibitors.
Brain and nervous system stimulation: Procedures such as vagus nerve stimulation, transcranial magnetic stimulation, and electroconvulsive therapy may be effective treatment options for major depressive disorder. These procedures are often used in treatment-resistant cases or when severe symptoms need to be alleviated more quickly than other treatments allow.
Physical activity: Even brief exercise at a moderate intensity can improve mood in both the short and long term, especially for mild to moderate depression.
Social support: Having strong social support can reduce feelings of loneliness and isolation in people with depression. It may also help prevent depression in at-risk individuals.
Is MDD considered a serious mental illness?
Clinical depression, also called major depressive disorder, is classified as a serious mental illness. Symptoms of severe depression, such as decreased concentration, sleep disturbances, and low self-worth, can cause severe functional impairment, affecting someone’s ability to work, socialize, participate in leisure, care for dependents, or consistently engage in healthy behaviors. For example, a depressed person may constantly feel tired, making it hard to take care of themselves and connect with other people.
Can MDD be cured?
There is no cure for major depression, but about half of the people who experience a depressive episode will not experience another one. For those with recurrent major depressive disorder, treating depressive episodes and preventing depression in the future may be more realistic. There are many effective methods of treating depression, including psychotherapy and antidepressant medications. Leaving depression untreated can have harmful consequences, such as an increased risk of heart disease, stroke, and other medical conditions.
What does a depressive episode look like?
Depressive episodes may involve feelings of sadness and emptiness and a loss of interest in activities. A person with depression can also experience sleep issues, lack of energy, and poor concentration. It is worth mentioning that depressive symptoms can vary significantly depending on the severity of the depressive episodes. According to the American Psychiatric Association, the diagnostic criteria for depression include:
Significant body weight changes, i.e., weight gain or weight loss
Loss of interest or pleasure in previously enjoyed activities
Depressed mood
Fatigue or loss of energy
Insomnia or hypersomnia
Difficulty concentrating
Feelings of guilt and self-reproach
Recurrent thoughts of death and suicide, with or without suicide attempts
If you or someone you know is dealing with thoughts of suicide or self-harm, call or text the 988 Suicide & Crisis Lifeline at 988.
What is the deepest stage of depression?
The deepest stage of depression is "severe depression." It can involve intense depressive symptoms, such as persistent depressed mood, feelings of worthlessness, anhedonia, agitation, and suicidal thoughts. Some people may only experience these symptoms once in their lives, but experiencing multiple episodes is common. It can help to seek professional help. Mental health professionals can create an individualized treatment plan to help improve the overall mental well-being of the patient.
What can trigger depressive symptoms?
A longstanding theory is that depression is caused by imbalances in brain chemistry, particularly serotonin levels. However, a 2022 study published in Molecular Psychiatry suggests that there is no convincing evidence that depression is caused by low serotonin activity. According to the World Health Organization, social, psychological, and biological factors can contribute to depression.
A systematic review and meta-analysis on the link between family history of psychiatric disorders and postpartum depression showed that new mothers with a family history of any psychiatric illness may be at an increased risk for developing postpartum depression. Childhood socioeconomic status may also play a role. A 2002 study showed that low socioeconomic status during childhood may be related to a higher lifetime risk of developing major depressive disorder in adulthood.
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